Differing myocardial response to a single session of hemodialysis in end-stage renal disease with and without type 2 diabetes mellitus and coronary artery disease

Abstract

BackgroundThough hemodialysis (HD) acutely improves cardiac function, the impact of background diseases like coronary artery disease (CAD) and Type 2 diabetes (DM) in the setting of end-stage renal disease (ESRD) is not known. Tissue velocity echocardiography (TVE) offers a fast choice to follow changes in myocardial function after HD in ESRD with concomitant DM and /or CAD.Methods46 subjects (17 with ESRD, Group 1; 15 with DM, Group 2; 14 with DM+CAD, Group 3) underwent standard and TVE prior to and shortly after HD. Besides standard Doppler variables, regional myocardial systolic and diastolic velocities, as well as systolic strain rate were post processed.ResultsCompared with pre-HD, post-HD body weight (kg) significantly decreased in all the three groups (51 ± 9 vs. 48 ± 8, 62 ± 10 vs.59 ± 10, and 61 ± 9 vs. 58 ± 9 respectively; all p < 0.01). Left ventricular end diastolic dimensions (mm) also decreased post- HD (46 ± 5 vs. 42 ± 7, 53 ± 7 vs. 50 ± 7, 51 ± 7 vs. 47 ± 8 respectively; all p < 0.01). Regional longitudinal peak systolic velocity in septum (cm/s) significantly increased post-HD in Group 1(5.7 ± 1.6 vs. 7.2 ± 2.3; p < 0.001) while remained unchanged in the other two groups. Similar trends were noted in other left ventricular walls. When the myocardial velocities (cm/s) were computed globally, the improvement was seen only in Group 1 (6.3 ± 1.5 vs. 7.9 ± 2.0; p < 0.001). Global early regional diastolic velocity (cm/s) improved in Group 1, remained unchanged in Group 2, while significantly decreased in Group 3(-5.9 ± 1.3 vs. -4.1 ± 1.8; p < 0.01). Global systolic strain rate (1/sec) increased in the first 2 Groups but remained unchanged (-0.87 ± 0.4 vs. -0.94 ± 0.3; p = ns) in Group 3.ConclusionA single HD session improves LV function only in ESRD without coexistent DM and/or CAD. The present data suggest that not only dialysis-dependent changes in loading conditions but also co-existent background diseases determine the myocardial response to HD.

Incremental value of global longitudinal strain in prediction of all-cause mortality in predialysis and dialysis chronic kidney disease patients

“…E/Em ratio is a reliable marker of increased LV filling pressure in a general cardiac population in those with LVsystolic dysfunction. Recently, a study in predialysis patients with moderate to severe chronic renal failure (stages [3][4][5] showed that CKD severity alone was positively associated with elevated LV filling pressure assessed by E/Em ratio [25]. Contrary to that we found that E/Em increases the predictive power in dialysis group.…”

“…Majority of the studies have demonstrated the association of CKD to strain deformation parameters. Mainly global longitudinal strain (GLS) was significantly related with the decline of renal function [4][5][6][7][8]. Only a few stud- 1 3 ies evaluated the prognostic value of GLS in patients with CKD in different stages of chronic renal failure [9,10].…”

Advanced Left Ventricular Diastolic Dysfunction in Uremic Patients With Type 2 Diabetes on Maintenance Hemodialysis

“…Additionally, the previous study was relatively small. 25 To our knowledge, the present study is the first to use pulsed-wave TDI to directly compare echocardiographic differences between ESRD patients with type 2 DM and those without DM on maintenance hemodialysis in a relatively large cohort study. Interestingly, ESRD patients with DM had a more pronounced diastolic dysfunction than the non-DM group, as evidenced by a significantly lower e' and higher E/e', regardless of the LV mass.…”

Acute administration of a single dose of valsartan improves left ventricular functions: a pilot study to assess the role of tissue velocity echocardiography in patients with systemic arterial hypertension in the TVE‐valsartan study I

“…Measured variables were isovolumic contraction times (IVCT) and velocities, isovolumic relaxation times (IVRT), ejection times (ET, defined by the period between aortic valve opening and closure), peak systolic velocities, early (E′) and late (A′) diastolic velocities and filling times (summation of early and late diastolic filling times) were calculated from the tissue velocity profile (Govind et al. , 2006).…”